Category Archives: Diabetes

Losing weight is not enough. Keeping your weight off is as important, if not more important, as taking it off. While Diets and Other Unnatural Acts teachs you to slowly improve your overall health by “Chicken Steps,” there are times when patients don’t have the luxury of waiting.

When obesity threatens your life, rapid, safe weight loss is essential. When I have a patient who needs to lose weight now, I send them to Betsy Weisbach, the founder of Exchanges Weight Management Consulting, Inc. (847-338-0987). Betsy is a master at finding my patients’ triggers and helping them achieve rapid weight loss.

Joline is 56 years old, weighed 256 pounds on a 5 foot 1 inch frame, had uncontrolled diabetes, hypertension and hypertriglyceridemia. Joline had been on every diet known to mankind and had failed to lose weight over the long-term. Actually, Joline gains back more weight than she loses each and every time she diets.

Joline was on nine medications, two of which were insulin-derived. She really needed a 10th medication but the expense of her medical care was overwhelming her. Joline had a life threatening disease called Metabolic Syndrome. She needed to lose weight and maintain that weight loss. She did not have the luxury of taking a “Chicken Step” approach.

With Betsy Weisbach’s help, Joline has lost 50 pounds in the last 6 months. Joline’s blood sugar, blood pressure, and triglycerides are much better. As Joline succeeds, her need for more medication has vanished. Her insulin requirements have lessened to the degree that she only takes one shot of insulin a day. She hopes to get off insulin altogether.

Joline has won half the battle. Now comes the hard part; the part Joline has never been able to accomplish. Joline needs to transition from Betsy’s diet to the new, healthier, “Joline” diet. Joline is reading Diets and Other Unnatural Actsand working with Betsy and me. Joline wants to be “Wellthy” and, for the first time, has found a team that can support her and a method that makes sense to her.

Congrats to Joline and those brave enough to face their demons and win! As I always say, “Remember, the life you save may be your own.”

Yesterday, the FDA announced new label changes (warnings) about the increased risks of elevated blood sugars and possible memory problems associated with the use of statins. At the same time, the FDA removed the recommendation for routine liver function testing that scared many patients out of taking statins in the first place.

Fear of statins has always been a problem.

Doc – “Mr. Impending Heart Attack, your cholesterol is elevated, you’re out of shape and overweight, and you need to go on a low cholesterol diet and start exercising. I also want to start you on a statin.”

Three months later and the patient is nowhere to be found. Four months later and Mr. Impending Heart Attack comes in for a cold.

Doc – “The good news is you are going to survive your cold. The bad news is your weight is up 5 pounds. We’ll recheck your cholesterol today. Your family history is lousy. It’s time to start that statin!”

Patient – “I’m afraid of statins. I’ve read about them on the internet and want to control my cholesterol with diet and exercise! This time will be different.”

Fear can be a fickle mistress. In this case, the risk of injury from a statin was very low and the risk of injury from the patient’s elevated cholesterol was very high. My patient’s father and grandfather both had their first heart attacks in their fifties!

Doctors treat patients based on a risk/benefit ratio. All of life carries risks and benefits. The benefit of driving my car to work is immense! The risk of driving my car to work is real, as well. Sunday, a deer darted in front of my car. I barely missed a catastrophe!

So what do you do? Weigh the benefit of not having your first heart attack in your fifties against the perceived risk of injury to your liver. Decide on the most prudent path and then follow the rules! I was driving under the speed limit, with my seatbelt on in a well-maintained car with airbags. I was vigilant and braked in time. Had I hit the deer, I was as protected from injury as possible. When using any medication, follow the directions, do the necessary screening tests and follow up as directed! Your doc will lay out the safety measures necessary to keep you out of trouble.

In the case of statins, the FDA no longer feels there is a significant risk of liver injury. It appears the fear of liver injury from statins was unfounded and people spent years worrying about nothing.

Unfortunately, The FDA gives with one hand and takes away with the other!

Doc – “Mr. Impending Heart Attack, you have been promising to go on a low cholesterol diet and exercise for years and have gained 30 pounds since we first had this conversation. You are 56 years old; the same age your father was when he had his first MI. Statins don’t cause liver disease. The FDA says I don’t have to monitor your liver. Let’s get you started on …”

Here we go again! If you’re afraid of diabetes, go on a low cholesterol diabetic diet. Lose weight and exercise! If you are not going to change your lifestyle, go on the appropriate medication until you come to your senses. If your doc is prescribing a medication for you, it means your doc fears your underlying disease more than the consequences of medicating you. If your doc is worried about you, you should worry about you! Remember, the life you save may be your own!

Oops, I forgot to mention the problem with memory loss. I guess it’s because of the statin I’ve been taking for years!

You are 13 years old. Thirteen is a tough time in life. Your parents treat you like a kid; you think you are grown up. Your hair is curly. You want straight hair. You like girls. They don’t pay any attention to you. Being a teenager is awkward at times.

You wake up not feeling well. Despite the fact that you are always hungry and eating a lot, you have been losing weight. You can’t stop peeing. Your mom takes you to the doc and he runs all kind of tests. He tells you that you have diabetes. You’ve heard of diabetes and you don’t want it!

The doc tells you and your mom that you are going to have to learn everything there is to know about diabetes. You are going to have to prick your finger three times a day to measure your blood sugar. You hate blood, especially your own. You hate pain and pricking your finger hurts. The doc tells you that you will have to inject yourself with medicine named insulin. You think this doc is nuts! You doc doesn’t understand! You are a 13 year old normal boy! You don’t have time for this crap!

NO ONE UNDERSTANDS! You are alone. Your parents tell you it will be ok. You’re sure it won’t. You feel like your life is over. Your parents aren’t doing so hot either. In front of you they as cool as ice. In private, they are scared. Diabetes is a complication they weren’t prepared for. Life is about to change.

The above scenario plays out every day across this country. Patients with diabetes and their families learn to deal with the disease. Some do better than others. So, where do you turn if it’s you or your kid. There are lots of support groups. Jimmy Insulin, a not for profit organization started by one of my patients, is one of the first places to turn to.

Jeremy Weisbach, the founder of Jimmy Insulin states: “Jimmy Insulin believes one-on-one support is essential for the physical, mental, social, and emotional well being of those with diabetes. People with diabetes can have a better way to transition and live in their new world by interacting with those who have been previously diagnosed.

Our organization is dedicated to enhancing the lives of anyone touched by this condition. Jimmy Insulin guides those with diabetes and their caregivers through their individual journey.

No one with diabetes will feel isolated as long as Jimmy Insulin exists.”

The 13 year old with newly diagnosed diabetes has a right to feel alone. A 13 year old often feel like no one understands them. Diabetes complicates matters. Having access to others who “been there, done that” should help the newly diagnosed diabetic find his way back to health.

This holiday season, reach out to Jimmy Insulin and other patient advocacy groups. Your help and contributions are needed.

Last week, I published an article on “Diabesity.” I have often thought about using the word “Diabetiholic” to describe many of my diabetic patients. A few days ago, I saw a recovering “Diabetiholic.” It was a great experience and I want to share it with you.

Mr. “X” has been a “Diabetiholic” for many years. “Diabetiholics” give lip service to treating their diabetes. While they will take medication, sit through long lectures on treating diabetes, and even see diabetic trainers, they refuse to change their eating habits. They can’t. Like an alcoholic, they can’t give up their sweets, their fats, and their lifestyle. Treating a “Diabetiholic” is both frustrating and dangerous.

“Diabetiholics” grow fat, develop diabetic neuropathy (nerve damage), diabetic nephropathy (kidney damage), and vascular disease (heart attack). They complain about the expense of their medication. They complain about their health. Their families don’t understand why the docs just keep on giving their loved one more medication and why their loved one keeps getting sicker!

Once in a while, I get the pleasure of treating a recovering “Diabetiholic.” Mr. “X” has seen the light. I’m not sure what transformed him, but he is well on the road to recovery. Why am I so sure that Mr. “X” will succeed? Often, it’s the little things that make a difference! Mr. “X” shared a little thing with me on his last visit.

Whenever Mr. “X” stopped to gas up his car, he would buy a bag of candy. Mr. “X” would feel guilty about eating the candy, but he would eat it anyway. Since starting on his journey to recovery, Mr. “X” has stopped buying his gas station candy. When he related this story to me, he did so with pride! He had taken ownership of his behavior and exercised his “willpower.” This one little “chicken step” is as monumental as the first step Mr. “X” took as a toddler.

I applauded Mr. “X’s” accomplishment and talked to him about the rest of his new journey. I was pleased to find that he was three steps ahead of me and moving in the right direction. Like the toddler, his first step was followed by a second and third. Mr. “X” will soon be running and jumping ahead with the goal of weaning his medications and living a healthier and happier life.

Like the toddler first learning to walk, Mr. “X” is bound to stumble and fall; but, like the toddler, he will learn to get up, brush himself off, and keep on running.

If you are a “Diabetiholic,” learn from Mr. “X.” It only takes one small step to start your journey to recovery. “Diets and Other Unnatural Acts” (now available on Amazon and in the office) can help point you in the right direction. Travel safely this holiday season. Share your blessing and get “Wellthy!”

On September 5th of this year, I published “Life-Betes.” A patient who had conquered diabetes introduced me to the term and I fell in love with it. My patient’s attitude converted a potentially devastating disease she called “die-betes” into a positive, “live-betes.” Instead of giving into the disease, she conquered it!

Today, I read an article by Mark Hyman, M.D. His article, “8 Steps to Reversing Diabesity,” introduced me to another new term I plan to adopt. Dr. Hyman states, “This disease is “diabesity,” the continuum of abnormal biology that ranges from mild insulin resistance to full-blown diabetes.”

While I don’t agree with some of Dr. Hyman’s recommendations, I am in complete agreement with his assessment of the magnitude and source of the problem. Lifestyle and nutrition are major contributors to “diabesity.” The primary treatment of “diabesity,” or diabetes as it is commonly known, is diet and exercise stemming from fundamental changes in lifestyle. Medications, either oral or injectable, are adjuncts (add-ons) and complement lifestyle changes.

Over the last year, I have written articles about pre-diabetes, managing diabetes, about successful patients who excelled at taking control of diabetes, and Maki Ogino, PA-C wrote about controlling diabetes from a diabetic’s perspective. All of these articles stressed the importance of taking control of the disease from the first diagnosis. Diabetes/diabesity can be the best thing that ever happened to a patient. It can be the turning point in an individual’s life. It can become, “life-betes.”

Diabetes can be the worst thing that happens in a patient’s life. It can slowly whittle away at your health, your “wellth,” and your finances. So, why not take control of it? What’s so hard about eating a healthy, diabetic diet and exercising? Why is it so hard to change your lifestyle especially if your life depends on it?

Change is scary! Changing from your own diet and lifestyle to a diabetic diet and lifestyle can be overwhelming! When I told Patient “A” that she had diabetes and needed to change her habits, she stated she didn’t have time to deal with being sick; she just wanted pills! She envisioned having to radically change her life and it seemed impossible. When I explained the concept of “chicken steps” (Diets and Other unnatural Acts), changing a little over a long period of time, she realized she could do what she needed to do to take control of her diabetes and her life.

My sleep apnea (http://livewellthy.org/2011/08/12/sleep-apnea-revisited.aspx) is much better. I have spent years fighting with my CPAP machine. Unlike most patients, I just couldn’t get used to wearing a mask. Knowing that sleep apnea has the potential to cause serious medical problems, I struggled to make peace with my sleep mask and the mechanical wonder it was attached to.

One consequence of writing this blog is that I have lost 30 pounds and am healthier than I have been in years. It’s amazing what happens to you when you follow the doc’s advice! Of all the benefits I have experienced since losing my weight, getting rid of my CPAP machine is the greatest. I no longer snore. I no longer wear a mask to bed. The only rhythmic noise in my room at night is my dog’s snoring!

According to MedPageToday, patients with sleep apnea who were enrolled in a study on the intensive treatment of diabetes had a significant decrease in their sleep apnea scores (improvement in sleep apnea).

The article stated, “The findings came from Sleep AHEAD, an ancillary study of the Look AHEAD trial, which compared an intensive lifestyle intervention with diabetes support and education for weight loss in obese patients with type 2 diabetes.” It went on to say that, After one year, patients undergoing the intensive lifestyle intervention lost an average of 24 pounds, whereas those in the control group had no weight loss (P<0.0001).

While the effects of lifestyle change and weight loss were not as pronounced as mine, they were significant. The author stated, “I don’t want to give you the impression that this is an alternative treatment to [continuous positive airway pressure],” he said. “It’s probably a complementary treatment.”

So, what have you got to lose? Ten, twenty or thirty pounds? A four pound CPAP machine? Even if you have to continue using your CPAP, you’ll be healthier.

How do you lose ten to thirty pounds when diets have failed you in the past? Stayed tuned to this blog. “Diets and Other Unnatural Acts” should be available by early December. I’ll give you a hint. Define who you are and then work at refining who you are.

I love “wows” and one of my diabetic patients gave me a great present last week. She has mastered her diabetes, living a healthy lifestyle and taking full responsibility for her own wellbeing. Her numbers are perfect. She takes her medications like clockwork. Her diet and exercise routine couldn’t be better. More importantly, she is happy, sporting a beautiful smile.

“Life-betes” is the name she coined for her disease. In the old days, “die-betes” was an appropriate name. With all that modern medicine has to offer, too many people die from complications of diabetes. According to the American Diabetic Association fact sheet, in 2007, diabetes contributed to 231,404 deaths in the United States.

Several years ago, I did a series of lectures on diabetes. The lecture was designed for patients and I upset several members of every audience by saying, “Diabetes may be the best thing that ever happens to you.” Audience members who were suffering with diabetes could not understand how I could make such an “outrageous” statement.

Most people take their health for granted, never realizing what a loss illness causes until it is too late. Those diabetics, like the angel described above, who marry their diagnoses and then change their lifestyles, often, as a result of those changes, end up happier and healthier than they had been in a long time.

“Life-betes” is a beautiful term. “Life-betes” is a way of life. “Life-betes” accepts that the disease is for life but does not stop or limit life once you master it. “Life-betes” is a positive way to look at an otherwise difficult cross to bear. “Life-betes” takes the die out of diabetes.

I always said that, if you can make something good come for something bad, the bad was not that bad after all. Take a lesson from this individual and learn to live and conquer whatever life throws at you.

Remember, the life you save may be your own. Put a positive spin on life and enjoy it to the max!

There are multiple costs to non-compliance, including financial, both personal and societal, and physical/emotional. Yesterday, I touched on the added personal costs associated with failure to follow-up with your doc as directed. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost. The societal cost of non-compliance will be the subject of a future article.

Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by R Sukol, MD, (http://www.kevinmd.com/blog/2011/08/doctors-diagnose-diabetes-10-years-disease-warrants.html). Dr. Sukol’s article discussed the fact that diabetes starts 10 years prior to your doc making a diagnosis and, if addressed early, often can be avoided. In her article, Dr. Sukol states, “I like my patient vertical. Not Horizontal.” Most docs have favorite sayings. My favorite is, “May you be so blessed as to never know what disease you prevented.” I’ll add Dr Sukol’s to my favorite list.

Another one of my favorite sayings is “There is no such thing as pre-diabetes. Pre-diabetes is like being pre-pregnant.” I wrote about pre-diabetes in January (http://livewellthy.org/2011/01/27/pre-diabetes.aspx). Dr Sukol’s article mentions pre-diabetes, a polite way of telling your patient you are on a 10 year journey to a very bad place. I diagnose my patients with diabetes way before the textbooks and convention recognizes that they are diabetic. Yes, on the record, I am politically correct in using that ridiculous term, pre-diabetes. Off the record, I want my patients to take their condition seriously and do something to positively change their future.

Ages ago, someone told me that life was like a movie playing on a VCR. His belief was that, at anytime, you could hit the eject button and put a new tape in that would then play to a different ending. When your doc identifies a condition, like pre-diabetes, the wise thing to do would be to immediately hit the eject button and insert a new tape.

Why don’t patients comply? Most just don’t have time to get healthy. They are too busy making a living and building a future. Unfortunately, they often build that future on a faulty foundation.

Your doc does not have a crystal ball. Dr. Sukol and I cannot tell you what your future holds. We can predict, with better accuracy than the weatherman, what is coming. We can tell you how to find shelter, how to survive the storm, or how to avoid it altogether. Help us help you! Pay attention to what we say. If you disagree with what we ask of you, tell us. If you don’t understand what we are saying, ask us to explain it better. If you can’t afford help, confide in us. We are your partners in health. Remember, the life you save may be your own!

If your doctor told you that you had diabetes, would you take insulin? Of course, you would! Everyone knows that diabetics need insulin and that taking medications that enhance or replace your own insulin improves your quality of life and prolongs life. Not taking insulin would be foolish.

If your doctor told you that your thyroid was malfunctioning and you needed to take a thyroid replacement, would you? Of course, you would! Hypothyroidism leads to weight gain, fatigue, weakness, constipation, decreased libido and hair loss. Taking thyroid replacement therapy (T3, T4) reverses all of these symptoms and allows you to live a normal life. Not taking T3 and T4 would be foolish.

If your doctor told you that you had depression and you needed to take an antidepressant, would you? Most people would not! They resist the idea that they need a pill to feel better. The term antidepressant has a negative connotation that is hard for me to understand! The term depression also has a negative connotation, as well. Why?

Depression is a condition related to a malfunction of the body’s own chemistry. It is no different than diabetes or hypothyroidism. In diabetes, the hormone called insulin is lacking, and therefore, the patient with diabetes becomes ill. In hypothyroidism, the hormones T3 and T4 malfunction and the patient becomes ill. In depression, the neurotransmitters, serotonin, norepinephrine and dopamine, are lacking, and the patient becomes ill! While it is acceptable to have and to treat diabetes and hypothyroidism, it is not acceptable to have depression. Why? Most people still live in the dark ages where depression is a stigma and embarrassment, a weakness. The situation is ludicrous.

Depression is an illness like any other. It is readily treatable. Medicine-like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) work to restore your brain’s natural chemical balance. They, like insulin,T3 and T4, have the ability to improve the quality of your life! Yes, it would be ridiculous not to take them when your doctor recommends this course.

In the future, I will tell my patients that their serotonin is malfunctioning and ask them to take a serotonin enhancing medication. They will ask me what happens when your serotonin malfunctions and I will answer, “You will get depressed.” Maybe that will make swallowing the pill a little easier. I look forward to the day when patients leave the dark ages and enter the world of enlightenment. They will be happier and my job will be easier.

According to an article published in “The Journal Of The American College of Cardiology,” a recent meta-analysis (scientific review) of 50 studies including 535,000 patients showed major health benefits from being on a “Mediterranean Diet.” Among the benefits of this diet are:

Improved systolic and diastolic blood pressure

Improved levels of HDL cholesterol

Improved triglyceride counts

Lower blood sugar levels

Improved waist circumference.

The “Mediterranean Diet” is rich in vegetables, fruits, whole grains and healthy oils, such as olive oil. A handful of nuts daily are an added bonus. Red meats are limited to a few servings a month. Eating fish and poultry at least twice weekly is advised. Another bonus is the diet allows for the ingestion of moderate amounts of red wine.

I have addressed diet in numerous previous articles and will continue to do so as an appropriate diet is a mainstay of “Living Wellthy.” The foundation of the “Living Wellthy” lifestyle encourages you to invest in your physical, nutritional, emotional and spiritual health retirement funds with the same fervor that you invest in your financial retirement fund. You should set a long-term goal for your nutritional account and that goal should be the healthiest diet that you can maintain long-term.

The “Mediterranean Diet” and others that I will write about in the weeks to come should be viewed as potential goals that can be realized by careful planning and sculpting of your current dietary habits. Remember, your diet is based on your family’s dietary habits, your national and religious heritage and your personal likes and dislikes. Your diet has been around for a long time and is, essentially, encased in concrete! Rather than trying to radically change it overnight, slowly chip away at it and mold it into something much healthier. Remember, the life you save may be your own.

Bio – Stewart Segal, MD

Dr Segal is a Board Certified Family Physician. He is the founder of Lake Zurich Family Treatment Center and a pioneer in open access medicine. He has been in practice for 32 years in Lake Zurich, Illinois. He is a physician educator, teaching both patients and physicians. He has served as a investigator in over 30 clinical trials. As evidenced by this blog and his office web site (www.lzftc.com), Dr Segal's passion is preventative medicine.

Disclosures

Dr Segal is the owner of Lake Zurich Family Treatment Center. Dr Segal has no ownership, stock or other financial interest in any pharmaceutical or device company.

Disclaimer

"The information provided on this blog is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with your physician or health care provider for your specific health care needs."